HRCT评分与血清标志物对类风湿关节炎合并肺间质病变的诊断价值

Diagnostic value of HRCT score and serum biomarkers for rheumatoid arthritis complicated with interstitial lung disease

目的:探讨HRCT评分与血清标志物的相关性,为类风湿关节炎合并肺间质病变(RA-ILD)的早期诊断与治疗提供参考。方法:回顾性分析284例RA患者的临床资料和胸部HRCT图像,其中单纯RA 152例,RA-ILD 132例。对2组行HRCT评分和28个关节疾病活动评分(DAS28)。收集2组病情活动指标:血沉(ESR)、C-反应蛋白(CRP)、类风湿因子(RF)、抗环瓜氨酸多肽抗体(ACCPA)、癌胚抗原(CEA)、甲胎蛋白(AFP)、糖类抗原724(CA724)、糖类抗原(CA19-9)、转铁蛋白(FeD)、纤维蛋白原(FIB)及D-二聚体(DDI3)。采用logistic回归分析及ROC曲线分析HRCT评分与各指标相关性,绘制各指标检测的AUC。结果:2组性别、年龄、DAS28、ESR、RF、CEA、CA19-9、HRCT评分差异均有统计学意义(均P<0.05);RA-ILD组患者年龄偏大,DAS28、RF、CEA、CA19-9、HRCT评分更高。多因素logistic回归分析表明,DAS28、RF、CEA、CA19-9可作为RA-ILD的独立预测指标。2组HRCT评分与年龄、DAS28、ESR、CEA、CA19-9、FIB均呈正相关(均P<0.05)。2组胸部HRCT评分及影像学特征比较,差异均有统计学意义(均P<0.05)。HRCT评分、ESR、RF、CA19-9、CEA、DAS28对应的AUC分别为0.762、0.486、0.526、0.786、0.778、0.870,敏感度分别为80.5%、73.2%、63.4%、75.6%、87.8%、80.5%。HRCT评分+RF+CEA+CA19-9、HRCT评分+ESR+DAS28+风湿3项+肿瘤标志物5项+凝血2项的AUC分别为0.947、0.959,敏感度分别为88.3%、82.9%。结论:HRCT评分+RF+CEA+CA19-9对可能存在继发ILD风险的RA患者具有潜在的诊断价值,可提高RA-ILD的早期诊断准确率和敏感度。

Objective:To explore the correlation between HRCT score and serum biomarkers for providing reference for early diagnosis and treatment of rheumatoid arthritis(RA)associated interstitial lung disease(ILD).Methods:A retrospective analysis of clinical and HRCT data of 284 RA patients was made.Among the 284 RA patients,132 cases were complicated with ILD(RA-ILD group),152 case were not(RA-N-ILD group).DAS28 and HRCT score evaluations were performed on the two groups.The serum biomarkers including ESR,CRP,rheumatoid factor(RF),anti-cyclic citrullinated peptide antibody(ACCPA),CEA,AFP,CA724,CA19-9,transferrin(FeD),fibrinogen(FIB)and D-dimer(DDI3)were collected.Logistic regression and ROC curve were used to analyze the correlation between HRCT score and indictors,and AUCs of each indicator were calculated.Results:There were statistical differences in gender,age,DAS28,ESR,RF,CEA,CA19-9,HRCT score between the two groups(all P<0.05),the patients in RA-ILD group were older and had higher levels of DAS28,RF,CEA,CA19-9 and HRCT score.Multivariate logistic regression analysis showed that DAS28,RF,CEA,CA19-9 could be used as independent predictors of RA-ILD.HRCT score was positively correlated with age,DAS28,ESR,CEA,CA19-9 and FIB(all P<0.05).Significant differences were also observed in HRCT score and imaging features between the two groups(all P<0.05).The AUCs for HRCT score,ESR,RF,CA19-9,CEA and DAS28 were 0.762,0.486,0.526,0.786,0.778 and 0.870,respectively,the corresponding sensitivities were 80.5%,73.2%,63.4%,75.6%,87.8%and 80.5%.The AUC and sensitivity of HRCT score combined with RF,CEA,CA19-9 were 0.947 and 88.3%,while those of HRCT score combined with ESR,DAS28,RF,tumor markers,coagulation markers were 0.959 and 82.9%.Conclusions:The combined application of HRCT score,RF,CEA and CA19-9 has the potential diagnostic value in RA patients who may have a risk of secondary ILD,and it can improve the early diagnostic accuracy and sensitivity of RA-ILD.